Provider Demographics
NPI:1508921750
Name:CHARLESTON NEUROLOGY ASSOCIATES, LLC
Entity Type:Organization
Organization Name:CHARLESTON NEUROLOGY ASSOCIATES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:WILLIAMS
Authorized Official - Last Name:PLYLER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:843-725-3530
Mailing Address - Street 1:9313 MEDICAL PLAZA DR
Mailing Address - Street 2:SUITE 310
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29406-9155
Mailing Address - Country:US
Mailing Address - Phone:843-569-1856
Mailing Address - Fax:843-569-1879
Practice Address - Street 1:9313 MEDICAL PLAZA DR
Practice Address - Street 2:SUITE 310
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29406-9155
Practice Address - Country:US
Practice Address - Phone:843-569-1856
Practice Address - Fax:843-569-1879
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-27
Last Update Date:2010-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC123632084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC471479Medicaid
SC471479Medicaid